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Journal Highlights From the January Issue of JAMDA

        Can Telepsychiatry Help Mental Health?

        Collaborative telepsychiatry can help reduce symptoms of depression and result in fewer trips to the hospital among older adults who have co-occurring chronic medical conditions, according to a study in southern California.
        Led by Nadereh Pourat, PhD, of the University of California–Los Angeles, researchers conducted an 18-month pre/post study that was implemented and funded by the Senior Care Action Network (SCAN) group, a Medicare Advantage plan.
        The topic has broad interest, especially in areas with a shortage of psychiatrists. “Using telehealth is a solution to address this challenge,” Dr. Pourat told Caring.
        For this study, primary care physicians made direct referrals for telepsychiatry for individuals with a history of “psychiatric hospitalizations, depression/anxiety disorders, co-morbid substance use disorder, or other comorbidities.” After a medical assistant had completed the Patient Health Questionnaire-9 (PHQ-9) to determine the severity of depression, individuals met virtually with a psychiatrist. Patients completed an average of six visits, including an initial evaluation (45–50 minutes) and 15- to 20-minute follow-up sessions to discuss medication. Primary care physicians administered the PHQ-9 about every three months during the study.
        Using Poisson regression to examine changes in predicted rates (per person per six months), the researchers found:
        • Outpatient services showed a 0.07 average semiannual increase in the two years before the first session; this average significantly declined by 0.24 in the two years after.
        • Emergency department visits showed a 0.02 average semiannual increase before the first session; they declined 0.07 in the 1.5 years after (the sample became too small to measure at two years).
        Hospitalizations had no change during the prior two years; they declined −0.03 in the first 1.5 years.
        PHQ-9 scores “among patients diagnosed with depression” increased in the six months before the first session and during the first three months after, but then showed a significant decline by nine months. The researchers also confirmed that “there were no significant differences in the PHQ-9 score for the population diagnosed with mental health conditions other than depression.”
        Although they were not required to do so for the study, many physicians also measured the Generalized Anxiety Disorder (GAD-7) score as needed. In their descriptive assessment, the researchers found “a significant decline in the average score (from 13. 8 to 8.4) as well as a decline in the percentage who had severe (52% to 19%) or moderate anxiety (26% to 22%).”
        “Understanding if the patients’ mental health status and other outcomes improve after receipt of telepsychiatry is important because it is an alternative to in-person care when in-person care is not possible or available,” Dr. Pourat said.
        As a result of improved mental health, patients may need fewer medical services. “This is because patients with mental health conditions may not be able to take care of themselves or follow physician’s orders,” Dr. Pourat said. “Addressing mental health conditions will potentially reduce frequent use of office visits, emergency department visits, or hospitalizations.”
        Source: Pourat N, et al. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults [published online: November 7, 2022]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2022.10.004.